“……….pretty much the whole race thus far I had felt nauseous and calories were not settling right. It felt like the struggle of being at altitude, like I’m fighting to get oxygen but there’s never enough. I felt continuously thirsty and my heart rate seemed to be way too high for the kind of effort I was putting forth.
The next 10k took me hours, as my body continually told me something was up, I went through cold sweats, unusual achiness that seemed unwarranted from the day’s effort thus far and a heartbeat that would spike when I attempted to run.”
This is Timothy Olson speaking, a few days after his ill-fated participation at the 2015 Lavaredo Ultra Trail. Just three years earlier he had blown away the ultra running community by both winning and setting a new record of 14:46:44 at the iconic Western States Endurance Run, and then followed that up by winning it again in 2013 and arriving 4th at the UTMB in the same year. The performance in the race around Cortina was not an isolated incident but just the latest in a series of sub par performances. In two years Timothy Olson had gone from one of the fastest Ultratrail athletes on the planet to a number of DNFs and disappointing performances.
Tim Olson was not the first runner to suffer this down spiral of performance. Here is previous Western States Record holder Geoff Roes describing his burn out during 2012,“By the end of August, I was also experiencing severe muscle weakness, fatigue, numbness, tingling, anxiety, random pains throughout nearly everywhere in my body, swollen eyelids, GI pain/issues, “brain fog,” severe lack of coordination/balance, and significant fluctuations in body temperature, appetite, blood sugar, and blood pressure.”
How does a highly trained athlete go from being one of the best in the world to having these kinds of symptoms and an inability to finish, and in some cases such as Geoff Roes, even contemplate participating in races?
As we are aware the training process works as we push our bodies, the muscles and cardio-pulmonary system through a series of steadily longer or more intense sessions, while allowing suitable time for rest and recovery according to the law of “Supercompensation” (Weigert ) and the “General Adaptation Syndrome (Hans Selye). The correct cycle of training and recovery will enable the athlete’s body to become stronger and faster. As the organism becomes steadily more fatigued it will reach a point of “Functional Overreaching” (FO) and, as long as this point is recognised and recovery is immediately allowed, this is actually a positive stage in the training cycle. The problem arises when the athlete, almost always without realising it, passes from FO to “Overtraining Syndrome” (OTS). As athletes we are accustomed to feeling tired, that our muscles ache and we have ups and downs in our training cycle. It is a normal feeling, until suddenly it isn’t! So what is OTS, how can it be recognised, what should we do to prevent it and how can it be cured?
One of the first evaluations of OTS within scientific research is dated 1993. In their article “Overtraining in endurance athletes: a brief review”, authors Lehmann, Foster and Keul state that “Overtraining is an imbalance between training and recovery, exercise and exercise capacity, stress and stress tolerance. Stress is the sum of training and non training stress factors.”. This was followed in 2002 by an article entitled “A practical approach to the overtraining syndrome” in which the author, Pearce, suggested that, “The overtraining syndrome is a chronic fatiguing illness that affects highly motivated endurance athletes. It is characterized by declining performance when maintaining a normal training program. The cause seems to be failure of adaptation within the neuroendocrine system, due to inadequate periods of rest.” However many scientists and medical professionals remained sceptical about the existence and definition of a similar malaise and in 2004, researchers Lalston and Jeukendrup published an article “Does Overtraining exist? An analysis of overreaching and overtraining research.” In which the conclusion reached was that “The available scientific and anecdotal evidence supports the existence of the overtraining syndrome; however, more research is required to state with certainty that the syndrome exists.”
More recent research supports the existence of OTS and an article published in 2012 “Overtraining Syndrome: A Practical Guide” (Jeffrey B Kreher MD and Jennifer B Schwarz MD) defined OTS as “…..a maladapted response to excessive exercise without adequate rest” and that this was caused by “……perturbations of multiple body systems (neurologic, endocrinologic and immunologic)…….” Citing, among others, possible causes such as “Oxidative Stress”, Autonomic Nervous System disorder”, “Central Fatigue” and “Hypothalmic disorder”. In this article the authors define three stages – Functional Overreaching (FO) (normal stress and recovery training cycle), Non Functional Overreaching (NFO) (a preliminary stage of OTS from which recovery can require several weeks or months) and Overtraining Syndrome (requiring many months or even years of treatment and in which some effects may be irreversible).
Having established that OTS exists and that it is a serious and debilitating condition, how can we as athletes recognise that we may have gone beyond functional overreaching and are straying firstly into the realm of NFO and subsequently OTS? Professor Tim Noakes in his comprehensive book “Lore of Running (2003) provided a list of evidence based signs and symptoms which could serve as warning signs for NFO and OTS. These were divided into the spheres of “Emotional” and “Physical”.
Emotional:
Loss of enthusiasm and drive; apathy, loss of joy in life
Loss of joy/thirst for competition; increased desire to quit during competition
Lethargy, listlessness, tiredness
Increased irritability, anxious, depressed, unable to relax, bored
Insomnia, changes in sleep patterns
Loss of appetite
Loss of libido
Poor coordination, general clumsiness
Increased fluid intake/thirst (namely in p.m.)
Physical:
Impaired physical performance; inability to complete routine training
Gradual loss of weight
Athlete looks drawn, sallow, dejected; sunken eyes
Increase in morning heart rate > 5 beats
Abnormal heart rate upon standing, during/after routine training
Slower recovery in heart rate after exertion
Postural hypotension
Persistent, progressive muscle soreness
Swelling of lymph glands
Gastrointestinal disturbances (with, without exertion)
Increased susceptibility to infection, allergies, headache, injury
Decreased tissue healing (minor scratches)
Loss of menstruation
Neurological, endocrine insufficiency
In his excellent series of articles for the website “irunfar.com”, physical therapist and coach Joe Uhan suggests that in order to diagnose OTS the following criteria should be met, but only after a complete rest period of between 2 to 4 weeks has been completed:-
1. Decreased performance “despite weeks or months of recovery”. This is a critical component of diagnosis of true OTS (versus FO or NFO). A distinguishing factor of OTS–versus other organic disease processes–is that the runner often demonstrates the ability to start a training session, but is unable to finish it.
2. Disturbances in mood. Pervasive mood changes–both in and out of training are present, usually coupled with a high workload and other life stressors.
3. Lack of signs/symptoms of other conditions or disease processes.
*Adapted from “Overtraining Syndrome: An Overview.” Joe Uhan (2013)
In reality fully blown OTS is fairly uncommon among amateur athletes, but NFO is much more likely, particularly within the field of endurance. Clearly the old adage “prevention is better than the cure” rings true, so it would be advisable for athletes to be looking for ways of preventing NFO or OTS, rather than waiting for it to be diagnosed and then finding the treatment. In which areas can we seek to improve our prevention strategy?
Nutrition and Hydration: Adopting a healthy diet and avoiding processed foods, including sugars and grains, which may have pro-inflammatory effects. Increasing intake of healthy anti-inflammatory foods – omega oils, nuts and berries. Limiting caffeine.
Relaxation: Sleeping well and sufficiently. Practicing yoga, meditation or deep breathing exercises.
Balancing: A healthy allocation of stress and non-stress – training and recovery. Ensuring a healthy balance between athletic based activities and other stresses such as work and family commitments. Respecting a healthy division between easy (low intensity) training and hard (high intensity) training – an ideal division could be considered as 80/20.
Variation: It’s not all about running. Physical fitness can also be maintained and improved through alternative activities and this variation in movement and activity can guard against the build up of stress. Cross training, biking or other mountain activities can be utilised. Even blander exercises such as walking and swimming can play an important role.
Perspective: Running is an important part of an athlete’s being but should not be viewed as the only or most important part of their lives. There are many other facets to life. No single training period or race result will make our lives great, nor will a poor performance destroy our lives.
The above are all steps, which the average amateur competitor can and should be able and prepared to put into practice – an adequate balance between training and recovery, following a healthy nutritional plan, ensuring that the accumulation of life stress and training stress is not excessive and building variation into training.
There are a number of athletes who credit their longevity to exactly this kind of approach. Meghan Arboghast , who arrived 13th at the recent World 100K Championship (incidentally breaking the 55-59 age group record in a time of 7h 58) in her 20th year of Ultra Running is a case in point. In a recent interview with Trail Runner magazine she stated “Being moderate in everything—eating, racing, training, sleeping—and not getting caught up in the "fear of missing out" mentality is key.”
In another Trail Runner Magazine interview, Karl “Speedgoat Meltzer” (48 years old and 36 100 mile wins) gave the following 5 tips: “Don’t race too much, recover fully, build volume slowly, listen to your body and take downtime.”
A specific programme for recovery from NFO or OTS does not exist, particularly since the symptoms, severity and individual susceptibility can vary among individuals. In all cases the immediate first step is that of halting any and all training. However, although this may be sufficient in the case of NFO, it will probably not be sufficient in the case of OTS, which has multifactorial causes. In this case other aspects such as nutritional, psychological and endocrinological will almost certainly have to be brought into play.
After his negative experiences Timothy Olson decided to take some time off from running, involving himself heavily with his coaching and mountain/running camp business where meditation and mindfulness play an important role. More recently he has taken part in a reality TV show and present indications are that he will return to serious competition in 2017.
Another elite athlete who has openly talked about her experience and struggles with OTS is New Zealander Anna Frost. In her case OTS was also a consequence of the Female Athlete Triad* (a hormonal balance resulting in various symptoms and problems). In 2014 she took a year off from running, travelling in various locations both in Asia and Europe, practiced yoga and meditation and adopted a healthy diet in which low carbs and high fat played an important role. Anna returned to competition in 2015 and has since won the Hardrock 100 in both that year and 2016. She credits much of her recovery and new-found success to having found an optimal physical and spiritual balance in which training stress is counter balanced by relaxation and healthy living.
In 2011 Mike Wolfe was on the crest of a wave when he decided to quit his job as a lawyer to concentrate on running full time. The result, as he freely admits, was OTS and a rapidly declining physical performance. He too decided to take time off from running, revised his mind-set and life objectives, went back to legal work in 2013 and has been steadily improving his performance and more importantly his enjoyment of it since then.
Other athletes such as Geoff Roes and Kyle Skaggs (previous Hardrock record holder) have not been so lucky and are still struggling with the long-term effects of OTS. In the case of Skaggs he has never returned to running and has deliberately distanced himself from the world of running.
* The Female Triad
In the most recent research and clinical observation the definition of the female triad has been modified to the term “Relative Energy Deficiency in Sport” (RED-S). “The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. The clinical phenomenon is not a 'triad' of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance.” The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S).
But this syndrome is not limited to females and can also be experienced by male athletes.
“Evidence shows that male athletes at particular risk are those in sports with a high training volume and in those which demand leanness or have weight categories. Male athletes in a variety of sports……………………. have been identified with disordered eating and eating disorders.”
“ ……………male athletes with relative energy deficiency have been shown to have decreased immunological function, impaired bone health, lower sex hormones and impaired reproductive function.” Margo Mountjoy, McMaster University, Canada (joint author of the IOC consensus statement).